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6 - Cognitive dysfunction: is chemobrain real?

from Section 2 - Cancer Symptom Mechanisms and Models: Clinical and Basic Science

Published online by Cambridge University Press:  05 August 2011

By
Christina A. Meyers  and
Jeffrey S. Wefel
Edited by
Charles S. Cleeland ,
Michael J. Fisch  and
Adrian J. Dunn
Christina A. Meyers
Affiliation:
The University of Texas M. D. Anderson Cancer Center
Jeffrey S. Wefel
Affiliation:
The University of Texas M. D. Anderson Cancer Center
Charles S. Cleeland
Affiliation:
University of Texas, M. D. Anderson Cancer Center
Michael J. Fisch
Affiliation:
University of Texas, M. D. Anderson Cancer Center
Adrian J. Dunn
Affiliation:
University of Hawaii, Manoa
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Summary

Cognitive dysfunction is ubiquitous in patients with cancer. It can be caused by various factors, including: (1) cancer in the central nervous system (CNS); (2) cancers outside the CNS that have remote effects on brain function; (3) cancer treatment; (4) adjuvant medication(s); and/or (5) neurological disorders unrelated to cancer. Long seen as a problem in the pediatric population, cognitive difficulties related to chemotherapy treatment are becoming recognized as a real phenomenon in adults as well.

Clinical research studies have used various definitions of cognitive impairment and different methodologies for assessment and statistical analysis which contributes to the variability in findings across studies. This chapter discusses both the preclinical and human studies that are advancing our knowledge of the effects of cancer and cancer treatment on brain function.

Chemobrain: a pattern of cognitive dysfunction

Adult patients with cancer who complain of “chemobrain” or “chemofog” typically report cognitive symptoms soon after they begin chemotherapy treatment. The most commonly described cognitive problems include difficulties with memory, attention, information-processing speed, and organization (ie, executive dysfunction). In patients with chemotherapy-related cognitive dysfunction, neuropsychological evaluation frequently uncovers difficulties sustaining focused attention that substantiate patient reports of episodes during which they have “spaced out” and lost their concentration. Deficits in working memory and executive function are also common and may correspond to patient reports of disorganization and difficulty multitasking. Measures of information-processing speed and fine motor function suggest further inefficiencies in cognitive and motor functioning.

Type
Chapter
Information
Cancer Symptom Science
Measurement, Mechanisms, and Management
 , pp. 51 - 59
Publisher: Cambridge University Press
Print publication year: 2010

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References

Butler, RW, Haser, JK. Neurocognitive effects of treatment for childhood cancer. Ment Retard Dev Disabil Res Rev 12(3):184–191, 2006.CrossRefGoogle ScholarPubMed
Alvarez, JA, Scully, RE, Miller, TL, et al. Long-term effects of treatments for childhood cancers. Curr Opin Pediatr 19(1):23–31, 2007.CrossRefGoogle ScholarPubMed
Hurria, A, Rosen, C, Hudis, C, et al. Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study. J Am Geriatr Soc 54(6):925–931, 2006.CrossRefGoogle ScholarPubMed
Schagen, SB, Muller, MJ, Boogerd, W, Mellenbergh, GJ, Dam, FSAM. Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients. J Natl Cancer Inst 98(23):1742–1745, 2006.CrossRefGoogle ScholarPubMed
Wefel, JS, Lenzi, R, Theriault, RL, Davis, RN, Meyers, CA. The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: results of a prospective, randomized, longitudinal trial. Cancer 100(11):2292–2299, 2004.CrossRefGoogle ScholarPubMed
Vardy, J, Wefel, JS, Ahles, T, Tannock, IF, Schagen, SB. Cancer and cancer-therapy related cognitive dysfunction: an international perspective from the Venice cognitive workshop. Ann Oncol 19(4):623–629, 2008.CrossRefGoogle ScholarPubMed
Heflin, LH, Meyerowitz, BE, Hall, P, et al. Cancer as a risk factor for long-term cognitive deficits and dementia. J Natl Cancer Inst 97(11):854–856, 2005.CrossRefGoogle ScholarPubMed
Roe, CM, Behrens, MI, Xiong, C, Miller, JP, Morris, JC. Alzheimer disease and cancer. Neurology 64(5):895–898, 2005.CrossRefGoogle ScholarPubMed
Wefel, JS, Meyers, CA. Cancer as a risk factor for dementia: a house built on shifting sand. J Natl Cancer Inst 97(11):788–789, 2005.CrossRefGoogle ScholarPubMed
Han, R, Yang, YM, Dietrich, J, Luebke, A, Mayer-Pröschel, M, Noble, M. Systemic 5-fluorouracil treatment causes a syndrome of delayed myelin destruction in the central nervous system. J Biol 7(4):12.1–12.22, 2008.CrossRefGoogle ScholarPubMed
Shilling, V, Jenkins, V, Morris, R, Deutsch, G, Bloomfield, D. The effects of adjuvant chemotherapy on cognition in women with breast cancer: preliminary results of an observational longitudinal study. Breast 14(2):142–150, 2005.CrossRefGoogle ScholarPubMed
Moleski, M. Neuropsychological, neuroanatomical, and neurophysiological consequences of CNS chemotherapy for acute lymphoblastic leukemia. Arch Clin Neuropsychol 15(7):603–630, 2000.CrossRefGoogle ScholarPubMed
Hermelink, K, Untch, M, Lux, MP, et al. Cognitive function during neoadjuvant chemotherapy for breast cancer: results of a prospective, multicenter, longitudinal study. Cancer 109(9):1905–1913, 2007.CrossRefGoogle ScholarPubMed
Jacobs, SR, Jacobsen, PB, Booth-Jones, M, Wagner, LI, Anasetti, C. Evaluation of the functional assessment of cancer therapy cognitive scale with hematopoietic stem cell transplant patients. J Pain Symptom Manage 33(1):13–23, 2007.CrossRefGoogle ScholarPubMed
Vardy, J, Wong, K, Yi, QL, et al. Assessing cognitive function in cancer patients. Support Care Cancer 14(11):1111–1118, 2006.CrossRefGoogle ScholarPubMed
Mehnert, A, Scherwath, A, Schirmer, L, et al. The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy. Patient Educ Couns 66(1):108–118, 2007.CrossRefGoogle ScholarPubMed
Jenkins, V, Shilling, V, Deutsch, G, et al. A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer. Br J Cancer 94(6):828–834, 2006.CrossRefGoogle ScholarPubMed
Silverman, DH, Dy, CJ, Castellon, SA, et al. Altered frontocortical, cerebellar, and basal ganglia activity in adjuvant-treated breast cancer survivors 5–10 years after chemotherapy. Breast Cancer Res Treat 103(3):303–311, 2007.CrossRefGoogle ScholarPubMed
Inagaki, M, Yoshikawa, E, Matsuoka, Y, et al. Smaller regional volumes of brain gray and white matter demonstrated in breast cancer survivors exposed to adjuvant chemotherapy. Cancer 109(1):146–156, 2007.CrossRefGoogle ScholarPubMed
Schneiderman, B. Hippocampal volumes smaller in chemotherapy patients. Lancet Oncol 5(4):202, 2004.CrossRefGoogle ScholarPubMed
Saykin, AJ, Ahles, TA, McDonald, BC. Mechanisms of chemotherapy-induced cognitive disorders: neuropsychological, pathophysiological, and neuroimaging perspectives. Semin Clin Neuropsychiatry 8(4):201–216, 2003.Google ScholarPubMed
Madhyastha, S, Somayaji, SN, Rao, MS, Nalini, K, Bairy, KL. Hippocampal brain amines in methotrexate-induced learning and memory deficit. Can J Physiol Pharmacol 80(11):1076–1084, 2002.CrossRefGoogle ScholarPubMed
Yoshikawa, E, Matsuoka, Y, Inagaki, M, et al. No adverse effects of adjuvant chemotherapy on hippocampal volume in Japanese breast cancer survivors. Breast Cancer Res Treat 92(1):81–84, 2005.CrossRefGoogle ScholarPubMed
Kreukels, BP, Schagen, SB, Ridderinkhof, KR, et al. Effects of high-dose and conventional-dose adjuvant chemotherapy on long-term cognitive sequelae in patients with breast cancer: an electrophysiologic study. Clin Breast Cancer 7(1):67–78, 2006.CrossRefGoogle Scholar
Monje, ML, Mizumatsu, S, Fike, JR, Palmer, TD. Irradiation induces neural precursor-cell dysfunction. Nat Med 8(9):955–962, 2002.CrossRefGoogle ScholarPubMed
Dietrich, J, Monje, M, Wefel, J, Meyers, C. Clinical patterns and biological correlates of cognitive dysfunction associated with cancer therapy. Oncologist 13(12):1285–1295, 2008.CrossRefGoogle ScholarPubMed
Monje, ML, Toda, H, Palmer, TD. Inflammatory blockade restores adult hippocampal neurogenesis. Science 302(5651):1760–1765, 2003.CrossRefGoogle ScholarPubMed
Winocur, G, Vardy, J, Binns, MA, Kerr, L, Tannock, I. The effects of the anti-cancer drugs, methotrexate and 5-fluorouracil, on cognitive function in mice. Pharmacol Biochem Behav 85(1):66–75, 2006.CrossRefGoogle ScholarPubMed
Reiriz, AB, Reolon, GK, Preissler, T, et al. Cancer chemotherapy and cognitive function in rodent models: memory impairment induced by cyclophosphamide in mice [letter]. Clin Cancer Res 12(16):5000–5001, 2006.CrossRefGoogle Scholar
Crandall, J, Sakai, Y, Zhang, J, et al. 13-cis-retinoic acid suppresses hippocampal cell division and hippocampal-dependent learning in mice. Proc Natl Acad Sci U S A 101(14):5111–5116, 2004.CrossRefGoogle ScholarPubMed
Joshi, G, Sultana, R, Tangpong, J, et al. Free radical mediated oxidative stress and toxic side effects in brain induced by the anti cancer drug adriamycin: insight into chemobrain. Free Radic Res 39(11):1147–1154, 2005.CrossRefGoogle ScholarPubMed
Dietrich, J, Han, R, Yang, Y, Mayer-Pröschel, M, Noble, M. CNS progenitor cells and oligodendrocytes are targets of chemotherapeutic agents in vitro and in vivo. J Biol 5(7):22.1–22.23, 2006.CrossRefGoogle ScholarPubMed
Lee, GD, Longo, DL, Wang, Y, et al. Transient improvement in cognitive function and synaptic plasticity in rats following cancer chemotherapy. Clin Cancer Res 12(1):198–205, 2006.CrossRefGoogle ScholarPubMed
Gandal, MJ, Ehrlichman, RS, Rudnick, ND, Siegel, SJ. A novel electrophysiological model of chemotherapy-induced cognitive impairments in mice. Neuroscience 157(1):95–104, 2008.CrossRefGoogle ScholarPubMed
Shah, RR. Mechanistic basis of adverse drug reactions: the perils of inappropriate dose schedules. Expert Opin Drug Saf 4(1):103–128, 2005.CrossRefGoogle ScholarPubMed
Sul, JK, DeAngelis, LM. Neurologic complications of cancer chemotherapy. Semin Oncol 33(3):324–332, 2006.CrossRefGoogle ScholarPubMed
Sheline, GE, Wara, WM, Smith, V. Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys 6(9):1215–1228, 1980.CrossRefGoogle ScholarPubMed
Jahnke, K, Kraemer, DF, Knight, KR, et al. Intraarterial chemotherapy and osmotic blood-brain barrier disruption for patients with embryonal and germ cell tumors of the central nervous system. Cancer 112(3):581–588, 2008.CrossRefGoogle ScholarPubMed
Jansen, C, Miaskowski, C, Dodd, M, Dowling, G, Kramer, J. Potential mechanisms for chemotherapy-induced impairments in cognitive function. Oncol Nurs Forum 32(6):1151–1163, 2005.CrossRefGoogle ScholarPubMed
Taphoorn, MJB, Klein, M. Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3(3):159–168, 2004.CrossRefGoogle ScholarPubMed
Keime-Guibert, F, Napolitano, M, Delattre, JY. Neurological complications of radiotherapy and chemotherapy. J Neurol 245(11):695–708, 1998.CrossRefGoogle ScholarPubMed
Delattre, JY, Posner, JB. Neurological complications of chemotherapy and radiation therapy. In: Aminoff, MJ, ed. Neurology and General Medicine: the Neurological Aspects of Medical Disorders. New York: Churchill Livingstone, 1995:421–445.Google Scholar
Weiss, RB, Vogelzang, NJ. Miscellaneous toxicities. In: DeVita, VT, Hellman, S, Rosenberg, SA, eds. Cancer, Principles & Practice of Oncology. Philadelphia: J. B. Lippincott Company, 1993:2349–2358.Google Scholar
Kim, YA, Chung, HC, Choi, HJ, Rha, SY, Seong, JS, Jeung, HC. Intermediate dose 5-fluorouracil-induced encephalopathy. Jpn J Clin Oncol 36(1):55–59, 2006.CrossRefGoogle ScholarPubMed
Shuper, A, Stark, B, Kornreich, L, et al. Methotrexate treatment protocols and the central nervous system: significant cure with significant neurotoxicity. J Child Neurol 15(9):573–580, 2000.CrossRefGoogle ScholarPubMed
Linnebank, M, Pels, H, Kleczar, N, et al. MTX-induced white matter changes are associated with polymorphisms of methionine metabolism. Neurology 64(5):912–913, 2005.CrossRefGoogle ScholarPubMed
Haykin, ME, Gorman, M, Hoff, J, Fulbright, RK, Baehring, JM. Diffusion-weighted MRI correlates of subacute methotrexate-related neurotoxicity. J Neurooncol 76(2):153–157, 2006.CrossRefGoogle ScholarPubMed
Quinn, CT, Kamen, BA. A biochemical perspective of methotrexate neurotoxicity with insight on nonfolate rescue modalities. J Investig Med 44(9):522–530, 1996.Google ScholarPubMed
Forman, AD, Meyers, CA, Levin, VA. Neurotoxic effects of pharmaceutical agents IV: cancer chemotherapeutic agents. In: Dobbs, MR, ed. Clinical Neurotoxicology: Syndromes, Substances, Environments. Philadelphia PA: Saunders/Elsevier, 2009:372–381.CrossRefGoogle Scholar
Gilbert, MR, Armstrong, TS. Neurotoxicities. In: Kirkwood, JM, Lotze, MT, Yasko, JM, eds. Current Cancer Therapeutics. Philadelphia: Current Medicine, 1996:364–371.Google Scholar
Knobf, MT. Reproductive and hormonal sequelae of chemotherapy in women: Premature menopause and impaired fertility can result, effects that are especially disturbing to young women. Am J Nurs 106(3 Suppl):60–65, 2006.CrossRefGoogle ScholarPubMed
Molina, JR, Barton, DL, Loprinzi, CL. Chemotherapy-induced ovarian failure: manifestations and management. Drug Saf 28(5):401–416, 2005.CrossRefGoogle ScholarPubMed
Eberling, JL, Wu, C, Tong-Turnbeaugh, R, Jagust, WJ. Estrogen- and tamoxifen-associated effects on brain structure and function. Neuroimage 21(1):364–371, 2004.CrossRefGoogle ScholarPubMed
Jenkins, V, Shilling, V, Fallowfield, L, Howell, A, Hutton, S. Does hormone therapy for the treatment of breast cancer have a detrimental effect on memory and cognition? A pilot study. Psychooncology 13(1):61–66, 2004.CrossRefGoogle ScholarPubMed
Mottet, N, Prayer-Galetti, T, Hammerer, P, Kattan, MW, Tunn, U. Optimizing outcomes and quality of life in the hormonal treatment of prostate cancer. BJU Int 98(1):20–27, 2006.CrossRefGoogle ScholarPubMed
Green, HJ, Pakenham, KI, Headley, BC, et al. Altered cognitive function in men treated for prostate cancer with luteinizing hormone-releasing hormone analogues and cyproterone acetate: a randomized controlled trial. BJU Int 90(4):427–432, 2002.CrossRefGoogle ScholarPubMed
McEwen, BS, Alves, SE. Estrogen actions in the central nervous system. Endocr Rev 20(3):279–307, 1999.Google ScholarPubMed
Yaffe, K, Sawaya, G, Lieberburg, I, Grady, D. Estrogen therapy in postmenopausal women: effects on cognitive function and dementia. JAMA 279(9):688–695, 1998.CrossRefGoogle ScholarPubMed
Pusztai, L, Mendoza, TR, Reuben, JM, et al. Changes in plasma levels of inflammatory cytokines in response to paclitaxel chemotherapy. Cytokine 25(3):94–102, 2004.CrossRefGoogle ScholarPubMed
Tsavaris, N, Kosmas, C, Vadiaka, M, Kanelopoulos, P, Boulamatsis, D. Immune changes in patients with advanced breast cancer undergoing chemotherapy with taxanes. Br J Cancer 87(1):21–27, 2002.CrossRefGoogle ScholarPubMed
Penson, RT, Kronish, K, Duan, Z, et al. Cytokines IL-1beta, IL-2, IL-6, IL-8, MCP-1, GM-CSF and TNFalpha in patients with epithelial ovarian cancer and their relationship to treatment with paclitaxel. Int J Gynecol Cancer 10(1):33–41, 2000.CrossRefGoogle ScholarPubMed
Wood, LJ, Nail, LM, Gilster, A, Winters, KA, Elsea, CR. Cancer chemotherapy-related symptoms: evidence to suggest a role for proinflammatory cytokines. Oncol Nurs Forum 33(3):535–542, 2006.CrossRefGoogle ScholarPubMed
Lee, BN, Dantzer, R, Langley, KE, et al. A cytokine-based neuroimmunologic mechanism of cancer-related symptoms. Neuroimmunomodulation 11(5):279–292, 2004.CrossRefGoogle ScholarPubMed
Scheibel, RS, Valentine, AD, O'Brien, S, Meyers, CA. Cognitive dysfunction and depression during treatment with interferon-alpha and chemotherapy. J Neuropsychiatry Clin Neurosci 16(2):185–191, 2004.CrossRefGoogle ScholarPubMed
Valentine, AD, Meyers, CA, Kling, MA, Richelson, E, Hauser, P. Mood and cognitive side effects of interferon-alpha therapy. Semin Oncol 25(1 Suppl 1):39–47, 1998.Google ScholarPubMed
Cunningham, RS. Anemia in the oncology patient: cognitive function and cancer. Cancer Nurs 26(6 Suppl):38S–42S, 2003.CrossRefGoogle ScholarPubMed
Birgegård, G, Aapro, MS, Bokemeyer, C, et al. Cancer-related anemia: pathogenesis, prevalence and treatment. Oncology 68(Suppl 1):3–11, 2005.CrossRefGoogle ScholarPubMed
O'Shaughnessy, JA, Vukelja, SJ, Holmes, FA, et al. Feasibility of quantifying the effects of epoetin alfa therapy on cognitive function in women with breast cancer undergoing adjuvant or neoadjuvant chemotherapy. Clin Breast Cancer 5(6):439–446, 2005.CrossRefGoogle ScholarPubMed
Groopman, JE, Itri, LM. Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst 91(19):1616–1634, 1999.CrossRefGoogle ScholarPubMed
Shapiro, CL, Recht, A. Side effects of adjuvant treatment of breast cancer. N Engl J Med 344(26):1997–2008, 2001.CrossRefGoogle ScholarPubMed
Jensen, BV. Cardiotoxic consequences of anthracycline-containing therapy in patients with breast cancer. Semin Oncol 33(3 Suppl 8):S15–S21, 2006.CrossRefGoogle ScholarPubMed
Johnson, SA. Anthracycline-induced cardiotoxicity in adult hematologic malignancies. Semin Oncol 33(3 Suppl 8):S22–S27, 2006.CrossRefGoogle ScholarPubMed
Lipshultz, SE. Exposure to anthracyclines during childhood causes cardiac injury. Semin Oncol 33(3 Suppl 8):S8–S14, 2006.CrossRefGoogle ScholarPubMed
Yahalom, J, Portlock, CS. Cardiac toxicity. In: DeVita, VT, Lawrence, TS, Rosenberg, SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2008:2678–2688.Google Scholar
Abratt, RP, Morgan, GW, Silvestri, G, Willcox, P. Pulmonary complications of radiation therapy. Clin Chest Med 25(1):167–177, 2004.CrossRefGoogle ScholarPubMed
Largillier, R, Etienne-Grimaldi, MC, Formento, JL, et al. Pharmacogenetics of capecitabine in advanced breast cancer patients. Clin Cancer Res 12(18):5496–5502, 2006.CrossRefGoogle ScholarPubMed
McAllister, TW, Ahles, TA, Saykin, AJ, et al. Cognitive effects of cytotoxic cancer chemotherapy: predisposing risk factors and potential treatments. Curr Psychiatry Rep 6(5):364–371, 2004.CrossRefGoogle ScholarPubMed
Okcu, MF, Selvan, M, Wang, , et al. Glutathione S-transferase polymorphisms and survival in primary malignant glioma. Clin Cancer Res 10(8):2618–2625, 2004.CrossRefGoogle ScholarPubMed
Krajinovic, M, Robaey, P, Chiasson, S, et al. Polymorphisms of genes controlling homocysteine levels and IQ score following the treatment for childhood ALL. Pharmacogenomics 6(3):293–302, 2005.CrossRefGoogle ScholarPubMed
Ahles, TA, Saykin, AJ, Noll, WW, et al. The relationship of APOE genotype to neuropsychological performance in long-term cancer survivors treated with standard dose chemotherapy. Psychooncology 12(6):612–619, 2003.CrossRefGoogle ScholarPubMed
Chen, Y, Lomnitski, L, Michaelson, DM, Shohami, E. Motor and cognitive deficits in apolipoprotein E-deficient mice after closed head injury. Neuroscience 80(4):1255–1262, 1997.CrossRefGoogle ScholarPubMed
Egan, MF, Kojima, M, Callicott, JH, et al. The BDNF val66met polymorphism affects activity-dependent secretion of BDNF and human memory and hippocampal function. Cell 112(2):257–269, 2003.CrossRefGoogle ScholarPubMed
Egan, MF, Goldberg, TE, Kolachana, BS, et al. Effect of COMT Val108/158 Met genotype on frontal lobe function and risk for schizophrenia. Proc Natl Acad Sci U S A 98(12):6917–6922, 2001.CrossRefGoogle ScholarPubMed
Valentine, AD, Meyers, CA, Talpaz, M. Treatment of neurotoxic side effects of interferon-alpha with naltrexone. Cancer Invest 13(6):561–566, 1995.CrossRefGoogle ScholarPubMed
Musselman, DL, Lawson, DH, Gumnick, JF, et al. Paroxetine for the prevention of depression induced by high-dose interferon alfa. N Engl J Med 344(13):961–966, 2001.CrossRefGoogle ScholarPubMed
Meyers, CA, Weitzner, MA, Valentine, AD, Levin, VA. Methylphenidate therapy improves cognition, mood, and function of brain tumor patients. J Clin Oncol 16(7):2522–2527, 1998.CrossRefGoogle ScholarPubMed
Barton, D, Loprinzi, C. Novel approaches to preventing chemotherapy-induced cognitive dysfunction in breast cancer: the art of the possible. Clin Breast Cancer 3(Suppl 3):S121–S127, 2002.CrossRefGoogle ScholarPubMed
Meyers, CA, Albitar, M, Estey, E. Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer 104(4):788–793, 2005.CrossRefGoogle ScholarPubMed
Konat, GW, Kraszpulski, M, James, I, Zhang, HT, Abraham, J. Cognitive dysfunction induced by chronic administration of common cancer chemotherapeutics in rats. Metab Brain Dis 23(3):325–333, 2008.CrossRefGoogle ScholarPubMed
Sanai, N, Tramontin, AD, Quiñones-Hinojosa, A, et al. Unique astrocyte ribbon in adult human brain contains neural stem cells but lacks chain migration. Nature 427(6976):740–744, 2004.CrossRefGoogle ScholarPubMed

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